Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism / Sophie CARRUTHERS in Autism Research, 13-4 (April 2020)  

Public ISBD [article]  inAutism Research > 13-4 (April 2020) . - p.506-522 Titre : Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism Type de document : Texte imprimé et/ou numérique Auteurs : Sophie CARRUTHERS, Auteur ; Andrew PICKLES, Auteur ; Vicky SLONIMS, Auteur ; Patricia HOWLIN, Auteur ; Tony CHARMAN, Auteur Article en page(s) : p.506-522 Langues : Anglais (eng) Mots-clés : autism  generalization  intervention research  learning  skill learning  social communication Index. décimale : PER Périodiques Résumé : Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation 'difficulties' associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506-522. (c) 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed. En ligne : http://dx.doi.org/10.1002/aur.2264 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=421 [article] Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism [Texte imprimé et/ou numérique] / Sophie CARRUTHERS, Auteur ; Andrew PICKLES, Auteur ; Vicky SLONIMS, Auteur ; Patricia HOWLIN, Auteur ; Tony CHARMAN, Auteur . - p.506-522. Langues : Anglais (eng) in Autism Research > 13-4 (April 2020) . - p.506-522 Mots-clés : autism  generalization  intervention research  learning  skill learning  social communication Index. décimale : PER Périodiques Résumé : Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation 'difficulties' associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506-522. (c) 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed. En ligne : http://dx.doi.org/10.1002/aur.2264 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=421

Brief Report: Testing the Psychometric Properties of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Autism Spectrum Disorder / Sophie CARRUTHERS in Journal of Autism and Developmental Disorders, 50-7 (July 2020)  

Public ISBD [article]  inJournal of Autism and Developmental Disorders > 50-7 (July 2020) . - p.2625-2632 Titre : Brief Report: Testing the Psychometric Properties of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Autism Spectrum Disorder Type de document : Texte imprimé et/ou numérique Auteurs : Sophie CARRUTHERS, Auteur ; Rachel KENT, Auteur ; Matthew J. HOLLOCKS, Auteur ; Emily SIMONOFF, Auteur Article en page(s) : p.2625-2632 Langues : Anglais (eng) Mots-clés : Anxiety  Autism spectrum disorder  Psychometrics  Screening tools Index. décimale : PER Périodiques Résumé : Anxiety is a prevalent and impairing co-morbidity among individuals with autism spectrum disorder (ASD), yet assessment measures, including screening tools, are seldom validated with autism samples. We explored the psychometric properties of the child and parent reports of the Spence Children's Anxiety Scale (SCAS) and the Screen for Anxiety Related Disorder-71 (SCARED-71) with 49 males with ASD (10-16 years, 63% co-occurring anxiety). Both measures had excellent internal consistency and fair-good parent-child agreement. The SCAS has a higher proportion of items evaluating observable behaviors. Predictive power of the measures did not differ. Higher cut-points in the parent reports (SCARED only) and lower cut-points in the child reports may enhance prediction in this sample. Choice of measure and cut-points should be considered alongside intended purpose. En ligne : http://dx.doi.org/10.1007/s10803-018-3774-8 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=426 [article] Brief Report: Testing the Psychometric Properties of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Autism Spectrum Disorder [Texte imprimé et/ou numérique] / Sophie CARRUTHERS, Auteur ; Rachel KENT, Auteur ; Matthew J. HOLLOCKS, Auteur ; Emily SIMONOFF, Auteur . - p.2625-2632. Langues : Anglais (eng) in Journal of Autism and Developmental Disorders > 50-7 (July 2020) . - p.2625-2632 Mots-clés : Anxiety  Autism spectrum disorder  Psychometrics  Screening tools Index. décimale : PER Périodiques Résumé : Anxiety is a prevalent and impairing co-morbidity among individuals with autism spectrum disorder (ASD), yet assessment measures, including screening tools, are seldom validated with autism samples. We explored the psychometric properties of the child and parent reports of the Spence Children's Anxiety Scale (SCAS) and the Screen for Anxiety Related Disorder-71 (SCARED-71) with 49 males with ASD (10-16 years, 63% co-occurring anxiety). Both measures had excellent internal consistency and fair-good parent-child agreement. The SCAS has a higher proportion of items evaluating observable behaviors. Predictive power of the measures did not differ. Higher cut-points in the parent reports (SCARED only) and lower cut-points in the child reports may enhance prediction in this sample. Choice of measure and cut-points should be considered alongside intended purpose. En ligne : http://dx.doi.org/10.1007/s10803-018-3774-8 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=426

The profile of pragmatic language impairments in children with ADHD: A systematic review / Sophie CARRUTHERS in Development and Psychopathology, 34-5 (December 2022)  

Public ISBD [article]  inDevelopment and Psychopathology > 34-5 (December 2022) . - p.1938-1960 Titre : The profile of pragmatic language impairments in children with ADHD: A systematic review Type de document : Texte imprimé et/ou numérique Auteurs : Sophie CARRUTHERS, Auteur ; Lauren J. TAYLOR, Auteur ; Hafiza SADIQ, Auteur ; Gail TRIPP, Auteur Article en page(s) : p.1938-1960 Langues : Anglais (eng) Mots-clés : ADHD  autism spectrum disorders  communication  pragmatic language Index. décimale : PER Périodiques Résumé : This systematic review synthesizes the empirical literature examining pragmatic language in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Using a taxonomy of pragmatic language, we compared the pragmatic language profiles of children with ADHD to those of typically developing (TD) children and children with autism. Three databases were searched up to October 2019: PsychInfo; PubMed; and CSA Linguistics and Language Behavior Abstracts. We included 34 studies reporting on 2,845 children (ADHD = 1,407; TD = 1,058; autism = 380). Quality and risk of bias assessments included sample size and representativeness; measure reliability and validity; and missing data management. Children with ADHD were found to have higher rates of pragmatic difficulties than their TD peers. Specific difficulties were identified with inappropriate initiation, presupposition, social discourse, and narrative coherence. Children with ADHD appear to differ from those with autism in the degree of their pragmatic language impairments. General language skills contribute to, but do not explain, pragmatic difficulties in samples of children with ADHD. Though the extant evidence is limited, a preliminary profile of the pragmatic language impairments in children with ADHD is indicated. This supports a call for evidence-based interventions that include pragmatic language skills training. En ligne : http://dx.doi.org/10.1017/S0954579421000328 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=492 [article] The profile of pragmatic language impairments in children with ADHD: A systematic review [Texte imprimé et/ou numérique] / Sophie CARRUTHERS, Auteur ; Lauren J. TAYLOR, Auteur ; Hafiza SADIQ, Auteur ; Gail TRIPP, Auteur . - p.1938-1960. Langues : Anglais (eng) in Development and Psychopathology > 34-5 (December 2022) . - p.1938-1960 Mots-clés : ADHD  autism spectrum disorders  communication  pragmatic language Index. décimale : PER Périodiques Résumé : This systematic review synthesizes the empirical literature examining pragmatic language in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Using a taxonomy of pragmatic language, we compared the pragmatic language profiles of children with ADHD to those of typically developing (TD) children and children with autism. Three databases were searched up to October 2019: PsychInfo; PubMed; and CSA Linguistics and Language Behavior Abstracts. We included 34 studies reporting on 2,845 children (ADHD = 1,407; TD = 1,058; autism = 380). Quality and risk of bias assessments included sample size and representativeness; measure reliability and validity; and missing data management. Children with ADHD were found to have higher rates of pragmatic difficulties than their TD peers. Specific difficulties were identified with inappropriate initiation, presupposition, social discourse, and narrative coherence. Children with ADHD appear to differ from those with autism in the degree of their pragmatic language impairments. General language skills contribute to, but do not explain, pragmatic difficulties in samples of children with ADHD. Though the extant evidence is limited, a preliminary profile of the pragmatic language impairments in children with ADHD is indicated. This supports a call for evidence-based interventions that include pragmatic language skills training. En ligne : http://dx.doi.org/10.1017/S0954579421000328 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=492

Using implementation science frameworks to explore barriers and facilitators for parents' use of therapeutic strategies following a parent-mediated autism intervention / Sophie CARRUTHERS in Autism, 27-4 (May 2023)  

Public ISBD [article]  inAutism > 27-4 (May 2023) . - p.1011-1025 Titre : Using implementation science frameworks to explore barriers and facilitators for parents' use of therapeutic strategies following a parent-mediated autism intervention Type de document : Texte imprimé et/ou numérique Auteurs : Sophie CARRUTHERS, Auteur ; Natasha MLECZKO, Auteur ; Stephanie PAGE, Auteur ; Shalini AHUJA, Auteur ; Ceri ELLIS, Auteur ; Patricia HOWLIN, Auteur ; Kathy LEADBITTER, Auteur ; Lauren TAYLOR, Auteur ; Vicky SLONIMS, Auteur ; Tony CHARMAN, Auteur Article en page(s) : p.1011-1025 Langues : Anglais (eng) Mots-clés : autism spectrum disorders,interventions - psychosocial/behavioural,qualitative research Index. décimale : PER Périodiques Résumé : One core component of the Paediatric Autism Communication Therapy-Generalised involves supporting parents to change their interaction and communication style with their child. This behaviour change has been found to affect child outcomes. Implementation science methodologies offer a range of opportunities to investigate how interventions are delivered in practice; however, few autism intervention studies have used such designs to explore the behaviour change of parents. We interviewed 27 parents and explored their use of intervention strategies after the Paediatric Autism Communication Therapy-Generalised trial. We employed the Theoretical Domains Framework and Consolidated Framework for Implementation Research to systematically explore a range of barriers and facilitators experienced by the parents associated with parents' characteristics, their context and features of the intervention. Our analysis revealed barriers and facilitators across three themes: Motivating Factors, which was further subdivided into Compatibility and Buy-In and Alignment of Goals and Outcomes; Opportunity and Support; Parent Characteristics. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators (e.g. parental confidence in using the strategies) and barriers (e.g. child?s behaviour) were identified. Consideration of these factors can inform identification of implementation strategies to test in future studies of Paediatric Autism Communication Therapy-Generalised and other parent-mediated early autism interventions.Lay abstractMany early autism interventions teach parents therapeutic strategies to help them adjust their communication style with their children. Research has shown that this behaviour change in parents leads to improvements in child communication. It is, therefore, important to learn what factors support or hinder parents in their use of therapeutic strategies learned in such interventions. This study set out to interview parents who had participated in a research trial of the Paediatric Autism Communication Therapy-Generalised intervention. We interviewed 27 caregivers and explored their use of the strategies up to 2?years after the end of the research trial. Qualitative frameworks were used to inform interview questions and data analysis. These frameworks focused on a range of contextual factors, including parents' characteristics, their context and features of the intervention. Parents reported barriers and facilitators to using Paediatric Autism Communication Therapy-Generalised strategies across three themes: Motivating Factors; Opportunity and Support; Parent Characteristics. One of these themes, Motivating Factors, was further divided into the subthemes Compatibility and Buy-In and Alignment of Goals and Outcomes. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators included parental confidence in using the strategies and barriers included child?s behaviour. Consideration of these factors can inform ways to better support parents in future autism interventions. En ligne : https://doi.org/10.1177/13623613221125630 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=499 [article] Using implementation science frameworks to explore barriers and facilitators for parents' use of therapeutic strategies following a parent-mediated autism intervention [Texte imprimé et/ou numérique] / Sophie CARRUTHERS, Auteur ; Natasha MLECZKO, Auteur ; Stephanie PAGE, Auteur ; Shalini AHUJA, Auteur ; Ceri ELLIS, Auteur ; Patricia HOWLIN, Auteur ; Kathy LEADBITTER, Auteur ; Lauren TAYLOR, Auteur ; Vicky SLONIMS, Auteur ; Tony CHARMAN, Auteur . - p.1011-1025. Langues : Anglais (eng) in Autism > 27-4 (May 2023) . - p.1011-1025 Mots-clés : autism spectrum disorders,interventions - psychosocial/behavioural,qualitative research Index. décimale : PER Périodiques Résumé : One core component of the Paediatric Autism Communication Therapy-Generalised involves supporting parents to change their interaction and communication style with their child. This behaviour change has been found to affect child outcomes. Implementation science methodologies offer a range of opportunities to investigate how interventions are delivered in practice; however, few autism intervention studies have used such designs to explore the behaviour change of parents. We interviewed 27 parents and explored their use of intervention strategies after the Paediatric Autism Communication Therapy-Generalised trial. We employed the Theoretical Domains Framework and Consolidated Framework for Implementation Research to systematically explore a range of barriers and facilitators experienced by the parents associated with parents' characteristics, their context and features of the intervention. Our analysis revealed barriers and facilitators across three themes: Motivating Factors, which was further subdivided into Compatibility and Buy-In and Alignment of Goals and Outcomes; Opportunity and Support; Parent Characteristics. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators (e.g. parental confidence in using the strategies) and barriers (e.g. child?s behaviour) were identified. Consideration of these factors can inform identification of implementation strategies to test in future studies of Paediatric Autism Communication Therapy-Generalised and other parent-mediated early autism interventions.Lay abstractMany early autism interventions teach parents therapeutic strategies to help them adjust their communication style with their children. Research has shown that this behaviour change in parents leads to improvements in child communication. It is, therefore, important to learn what factors support or hinder parents in their use of therapeutic strategies learned in such interventions. This study set out to interview parents who had participated in a research trial of the Paediatric Autism Communication Therapy-Generalised intervention. We interviewed 27 caregivers and explored their use of the strategies up to 2?years after the end of the research trial. Qualitative frameworks were used to inform interview questions and data analysis. These frameworks focused on a range of contextual factors, including parents' characteristics, their context and features of the intervention. Parents reported barriers and facilitators to using Paediatric Autism Communication Therapy-Generalised strategies across three themes: Motivating Factors; Opportunity and Support; Parent Characteristics. One of these themes, Motivating Factors, was further divided into the subthemes Compatibility and Buy-In and Alignment of Goals and Outcomes. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators included parental confidence in using the strategies and barriers included child?s behaviour. Consideration of these factors can inform ways to better support parents in future autism interventions. En ligne : https://doi.org/10.1177/13623613221125630 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=499

Utility of the Autism Diagnostic Observation Schedule and the Brief Observation of Social and Communication Change for Measuring Outcomes for a Parent-Mediated Early Autism Intervention / Sophie CARRUTHERS in Autism Research, 14-2 (February 2021)  

Public ISBD [article]  inAutism Research > 14-2 (February 2021) . - p.411-425 Titre : Utility of the Autism Diagnostic Observation Schedule and the Brief Observation of Social and Communication Change for Measuring Outcomes for a Parent-Mediated Early Autism Intervention Type de document : Texte imprimé et/ou numérique Auteurs : Sophie CARRUTHERS, Auteur ; Tony CHARMAN, Auteur ; Nicole EL HAWI, Auteur ; Young Ah KIM, Auteur ; Rachel RANDLE, Auteur ; Catherine LORD, Auteur ; Andrew PICKLES, Auteur Article en page(s) : p.411-425 Langues : Anglais (eng) Mots-clés : Autism Diagnostic Observation Schedule  Brief Observation of Social Communication Change  autism spectrum disorder  intervention  outcome measures  trials Index. décimale : PER Périodiques Résumé : Measuring outcomes for autistic children following social communication interventions is an ongoing challenge given the heterogeneous changes, which can be subtle. We tested and compared the overall and item-level intervention effects of the Brief Observation of Social Communication Change (BOSCC), Autism Diagnostic Observation Schedule (ADOS-2) algorithm, and ADOS-2 Calibrated Severity Scores (CSS) with autistic children aged 2-5?years from the Preschool Autism Communication Trial (PACT). The BOSCC was applied to Module 1 ADOS assessments (ADOS-BOSCC). Among the 117 children using single or no words (Module 1), the ADOS-BOSCC, ADOS algorithm, and ADOS CSS each detected small non-significant intervention effects. However, on the ADOS algorithm, there was a medium significant intervention effect for children with "few to no words" at baseline, while children with "some words" showed little intervention effect. For the full PACT sample (including ADOS Module 2, total n=152), ADOS metrics evidenced significant small (CSS) and medium (algorithm) overall intervention effects. None of the Module 1 item-level intervention effects reached significance, with largest changes observed for Gesture (ADOS-BOSCC and ADOS), Facial Expressions (ADOS), and Intonation (ADOS). Significant ADOS Module 2 item-level effects were observed for Mannerisms and Repetitive Interests and Stereotyped Behaviors. Despite strong psychometric properties, the ADOS-BOSCC was not more sensitive to behavioral changes than the ADOS among Module 1 children. Our results suggest the ADOS can be a sensitive outcome measure. Item-level intervention effect plots have the potential to indicate intervention "signatures of change," a concept that may be useful in future trials and systematic reviews. LAY SUMMARY: This study compares two outcome measures in a parent-mediated therapy. Neither was clearly better or worse than the other; however, the Autism Diagnostic Observation Schedule produced somewhat clearer evidence than the Brief Observation of Social Communication Change of improvement among children who had use of "few to no" words at the start. We explore which particular behaviors are associated with greater improvement. These findings can inform researchers when they consider how best to explore the impact of their intervention. En ligne : http://dx.doi.org/10.1002/aur.2449 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=441 [article] Utility of the Autism Diagnostic Observation Schedule and the Brief Observation of Social and Communication Change for Measuring Outcomes for a Parent-Mediated Early Autism Intervention [Texte imprimé et/ou numérique] / Sophie CARRUTHERS, Auteur ; Tony CHARMAN, Auteur ; Nicole EL HAWI, Auteur ; Young Ah KIM, Auteur ; Rachel RANDLE, Auteur ; Catherine LORD, Auteur ; Andrew PICKLES, Auteur . - p.411-425. Langues : Anglais (eng) in Autism Research > 14-2 (February 2021) . - p.411-425 Mots-clés : Autism Diagnostic Observation Schedule  Brief Observation of Social Communication Change  autism spectrum disorder  intervention  outcome measures  trials Index. décimale : PER Périodiques Résumé : Measuring outcomes for autistic children following social communication interventions is an ongoing challenge given the heterogeneous changes, which can be subtle. We tested and compared the overall and item-level intervention effects of the Brief Observation of Social Communication Change (BOSCC), Autism Diagnostic Observation Schedule (ADOS-2) algorithm, and ADOS-2 Calibrated Severity Scores (CSS) with autistic children aged 2-5?years from the Preschool Autism Communication Trial (PACT). The BOSCC was applied to Module 1 ADOS assessments (ADOS-BOSCC). Among the 117 children using single or no words (Module 1), the ADOS-BOSCC, ADOS algorithm, and ADOS CSS each detected small non-significant intervention effects. However, on the ADOS algorithm, there was a medium significant intervention effect for children with "few to no words" at baseline, while children with "some words" showed little intervention effect. For the full PACT sample (including ADOS Module 2, total n=152), ADOS metrics evidenced significant small (CSS) and medium (algorithm) overall intervention effects. None of the Module 1 item-level intervention effects reached significance, with largest changes observed for Gesture (ADOS-BOSCC and ADOS), Facial Expressions (ADOS), and Intonation (ADOS). Significant ADOS Module 2 item-level effects were observed for Mannerisms and Repetitive Interests and Stereotyped Behaviors. Despite strong psychometric properties, the ADOS-BOSCC was not more sensitive to behavioral changes than the ADOS among Module 1 children. Our results suggest the ADOS can be a sensitive outcome measure. Item-level intervention effect plots have the potential to indicate intervention "signatures of change," a concept that may be useful in future trials and systematic reviews. LAY SUMMARY: This study compares two outcome measures in a parent-mediated therapy. Neither was clearly better or worse than the other; however, the Autism Diagnostic Observation Schedule produced somewhat clearer evidence than the Brief Observation of Social Communication Change of improvement among children who had use of "few to no" words at the start. We explore which particular behaviors are associated with greater improvement. These findings can inform researchers when they consider how best to explore the impact of their intervention. En ligne : http://dx.doi.org/10.1002/aur.2449 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=441

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